1952303208 NPI number — DR. STEVEN A FERZOCO M.D.

Table of content: DR. STEVEN A FERZOCO M.D. (NPI 1952303208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952303208 NPI number — DR. STEVEN A FERZOCO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERZOCO
Provider First Name:
STEVEN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952303208
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 678063
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75267-8063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-620-7102
Provider Business Mailing Address Fax Number:
662-620-7106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 S RALEIGH AVE
Provider Second Line Business Practice Location Address:
STE 100A
Provider Business Practice Location Address City Name:
SHEFFIELD
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35660-6350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-620-7102
Provider Business Practice Location Address Fax Number:
662-620-7106
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  00023957 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD.23957 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009912081 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51524639 . This is a "BC OBGYN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51531407 . This is a "BC HALEYVILLE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51531408 . This is a "BC RUSSELLVILLE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009934437 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009986500 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009912017 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009934438 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: C300 . This is a "MC GROUP" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009978905 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 528202620 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51507878 . This is a "BC ECM" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51543277 . This is a "BC EAST" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51543312 . This is a "BC SHOALS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000055298 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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